Muscle atrophy in diabetic patients with Charcot foot: a case-control study

Area of Science:

• Diabetic foot complications
• Musculoskeletal imaging
• Neuropathy

Background:

• Diabetic foot complications, particularly Charcot foot (CF), are associated with significant morbidity.
• Muscle atrophy and edema are potential contributors to the pathophysiology of CF.
• Understanding the extent and characteristics of muscle changes in CF is crucial for diagnosis and management.

Purpose of the Study:

• To compare the distribution and severity of muscle atrophy in diabetic patients with active Charcot foot (CF) versus those without CF.
• To assess fatty muscle infiltration, muscle cross-sectional area (CSA), and intramuscular edema in both groups.
• To investigate the correlation between muscle atrophy and the severity of CF disease.

Main Methods:

• Retrospective analysis of MRI scans from 35 diabetic patients with active CF and an age/gender-matched control group.
• Evaluation of fatty muscle infiltration using the Goutallier classification by two independent readers.
• Assessment of muscle CSA, intramuscular edema, and CF disease severity (Balgrist Score).

Main Results:

• Severe fatty muscle infiltration and muscle edema were significantly more frequent in the CF group.
• Hindfoot muscle cross-sectional areas (CSAs) were significantly smaller in patients with CF.
• A hindfoot flexor digitorum brevis muscle CSA < 139 mm² showed 62.9% sensitivity and 82.9% specificity for differentiating CF.

Conclusions:

• Diabetic patients with active Charcot foot exhibit significantly more severe muscle atrophy and edema.
• Muscle atrophy severity does not correlate with the clinical severity of active Charcot foot.
• A reduced hindfoot flexor digitorum brevis muscle CSA may serve as an indicator for Charcot foot disease.